[A] group of seven people has less than five months to figure out how mandatory health insurance might work in Vermont.
On Tuesday morning, members of the Individual Mandate Working Group met for the first time. They’ve got until Nov. 1 to come up with recommendations on issues like administration, enforcement and exemptions for a state health insurance requirement that’s scheduled to take effect in 2020.
Tuesday’s meeting was largely focused on procedural issues. But group members also laid out a schedule that would enable them to meet their deadline for reporting to the Legislature later this year while allowing for numerous public meetings and a public comment period.
“We’ll certainly need to keep our nose to the grindstone, but I’m confident the group will get it completed,” said Robin Lunge, a Green Mountain Care Board member who’s serving on the individual mandate group.
On the last day of the 2018 regular legislative session, state lawmakers approved H.696 – now called Act 182 after Gov. Phil Scott endorsed it. The bill says that, as of Jan. 1, 2020, Vermonters must have “minimum essential” health coverage.
The state legislation was a reaction to pending changes at the federal level. There’s still a federal individual mandate in place, but Congress last year approved a tax overhaul that eliminates the financial penalty for those who don’t buy health insurance as of 2019.
That led to speculation that many people – mostly, presumably, the young and healthy – could choose to drop their health coverage next year. If that happens, it could drive up insurance premiums for those who maintain coverage.
In Vermont, policymakers and insurers already are planning for that to happen.
A recent state report predicts a 0.6 percent uptick in Vermont’s overall uninsured rate next year, along with a 1.6 percent to 2.4 percent increase in premiums for the individual and small group insurance markets. That’s equivalent to $8 million to $14 million in additional premium costs.
Also, both insurers for the state’s health care exchange have said a portion of their proposed rate hikes for 2019 are due to the loss of the federal individual mandate penalty.
After much debate, Vermont legislators chose not to enact a state individual mandate in 2019. Instead, the state’s mandate will take effect in 2020 in order to give officials time to figure out how to enforce and administer the law.
That’s where the working group comes in.
The group consists of seven members. In addition to Lunge, they are Addie Strumolo of the Department of Vermont Health Access; Emily Brown of the Department of Financial Regulation; Doug Farnham of the Tax Department; Mike Fisher, the state’s chief health care advocate; Sara Teachout of Blue Cross and Blue Shield of Vermont; and Susan Gretkowski of MVP Health Care.
Members spent part of Tuesday morning making decisions about how to move forward.
For instance, they decided not to elect a chair. Also, they said their meetings will be held at the Department of Financial Regulation’s office at 89 Main St. in Montpelier.
The working group’s next meeting is scheduled for 8:30 a.m. June 26. There are three more meetings tentatively scheduled in July, and possibly four in August. All are open to the public.
The plan is for the group to come up with draft recommendations in September, then allow about two weeks in October for public comment before finalizing the report.
A recommendation on how to enforce Vermont’s health insurance mandate might become the most divisive aspect of the group’s work. While most discussion has focused on a financial penalty for those who don’t buy insurance, a spokesperson for Scott has said “something like an incentive” would be better.
Act 182 says the Legislature must enact an “enforcement mechanism or mechanisms” for the individual mandate in the 2019 session. That language allows some flexibility for the working group.
“It’s important to note that (a financial penalty) is not the only option,” Lunge said. “We are free to look at any other enforcement mechanisms we can come up with.”
Group members also sought to build some additional flexibility into their deliberations: There was general agreement at Tuesday’s meeting that the group may be able to present more than one viewpoint in its final report.
“I can envision a recommendation that has multiple paths,” Strumolo said. “I think that might be beneficial to stay open to that idea.”
There is precedent for the working group’s discussions. Since last winter, a less-formal group has been meeting to talk about the potential impact of federal policy changes on health care in Vermont.
That group “did a lot of background research and collected information,” Lunge said.
“It was a much broader array of issues,” she said. “But one of the issues that group started to talk about were the pros and cons of an individual mandate at the state level.”
Fisher said he wants the collaborative spirit of those previous discussions to continue. “The real value of this group over time has been that people with a lot of expertise from a lot of parts of state government and beyond have been able to come to the table and give their input,” he said.
At the same time, the working group has to stay focused given its short lifespan: Act 182 says the group will cease to exist upon delivering its report on Nov. 1.
“Between now and November, that’s not actually a long time,” Farnham said. “And this is a pretty important issue.”
